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Surgery of the large intestine

Apr 14, 2012 , Danica Deretić

Surgery of the large intestine is among the most common surgical procedures. The surgery is performed on the final part of the digestive tract, the large intestine, which has several parts. The surgeries are of varying scale, possibly up to complete removal of the large intestine. There is a wide range of intestinal diseases and some of them are only curable via surgery.

Surgery of the large intestine

Surgery of the large intestine is among the most common surgical procedures. It can be indicated for various reasons and is often a life-saving procedure. Surgery of the large intestine is also often the only way of treating the given disease. The surgery is performed on the final part of the digestive tract, the large intestine, which is connected to the smaller intestine.

Anatomy and physiology of the large intestine

The large intestine is a tube about 1,5m long, its name stemming from its diameter, which can be up to 7,5cm. It is a hollow tube organ, connected to the smaller intestine on one side, leading into the rectum on the other one. The first part of the large intestine is called cecum, to which the appendix attached. The appendix is prone to inflammation, referred to as appendicitis. Cecum then leads upwards towards the liver as the ascending colon Under the liver it passes across the abdomen as transverse colon and to the left side under the spleen it turns down again as the descending colon. In the lower right quarter of the abdomen the large intestine leads into the sigmoid colon, ending in the rectum. The main function of the large intestine is to absorb water and remaining minerals from digested food coming from the smaller intestine. The result is the forming of stool. These functions are supported by the presence of naturally occurring intestinal bacteria.

Indication for surgery of the large intestine

Indication refers to a series of circumstances leading to the execution of a certain diagnostic or therapeutic procedure or treatment. There is a large number of intestinal diseases, which manifest mainly through blockage of the intestines. This is a serious, often life-threatening situation, which needs to be solved immediately via surgery. The symptoms include stomach pains, vomiting, diarrhea, constipation and lack of gas and also the presence of blood in stool. Metabolism of liquids and minerals is also afflicted. This situation can eventually result into a state of shock and even death of the patient. Caused of intestinal obstruction, ileus in medical terms, can be varied. Among the most common:

A benign tumor, known as a polyp, which is a growth of the mucous layer sticking through the surface to the inside of the intestine. Its main danger lies in the possibility of it turning into a malignant tumor.

A malignant tumor, also known as a colorectal carcinoma is one of the most common indications for surgery of the large intestine Depending on the size of the tumor, changes in the character of the stool, and frequency of defecating can occur, as well as stomach pains and presence of blood in stool. Surgery is the only way of treating a malignant tumor.

Diverticulitis is an inflammatory disease of the intestinal pouches, which causes stomach pains and occasionally bleeding. Surgery is performed only if complications are present. Complications include possibility of a rupture of a pouch, causing peritonitis, sepsis and possibly even death of the patient.

Crohn's disease is an inflammatory disease of the intestine with an unknown cause, typically starting on the end of the smaller intestine, spreading to other parts of the digestive tract, including the large intestine. Surgical procedure is the last choice of treatment with this disease, since it doesn't result in a complete recovery in most patients.

Ulcerous colitis is an inflammatory disease with and unknown cause starting in the rectum, spreading to nearby parts of the large intestine. This is a diagnosis only completely curable by surgery.

Diagnostics of intestinal diseases

Diagnosis of intestinal disease is based on a carefully performed anamnesis, the doctor's examination itself and the use of auxiliary diagnostic methods. Among the principal methods are x-ray and endoscopy. The most common method of first choice is an endoscopic examination of the large intestine, a colonoscopy. This is an exam, where a flexible device with a camera which allows the inspection of the large intestine, taking biopsy samples and if necessary, stopping bleeding is inserted into the intestine. It is also possible to remove any present polyps during this exam. An x-ray exam of the large intestine, irrigography, consists of filling the intestine with a contrast dye through the anus. An occult blood test is performed as a part of the screening, to reveal any bleeding not visible to naked eye.

Types of intestinal surgery

Surgery of the large intestine can only be performed on a previously cleaned intestine The surgeries can be divided based on several criteria. The basic division is into radical surgery, which removes the disease and palliative surgery, whose purpose is to prolong the patient's life and improve his quality of life. Intestinal surgery can be done by the standard method,by doing an abdominal incision of varying sizes, or by laparoscopy, via several small incisions, in which special surgical tools are inserted. Since cancer of the large intestine is among the most common worldwide, this is a very common surgery. A resection needs to be performed in the case of a malignant tumor. This means removing the afflicted part of the intestine, as well as any healthy parts nearby. In the case an entire left or right side of the intestine need to be removed, either due to the size or localization of the tumor, a surgery known as left or right hemicolectomy needs to be performed. The remaining part of the intestine is then sown together It's very important to remove any lymph nodes in the catchment area and send them to a biopsy. This is important for determining the stage of the disease as well as any prognoses.

Complications of intestinal surgery

Among the possible complications of intestinal surgery are bleeding of varying extent, based on the size of damaged blood vessels. This can lead to anemia and the necessity of a blood transfusion for the patient. Ureters can also be damaged, especially if the disease is cancerous. The damage usually takes the form of severing the ureter, which can cause renal failure. Another possible complication is the damage of the urinary bladder, which is a risk with tumors growing into this organ. Further complications are nerve injury, allergic reactions, high temperature, problems with urination, digestion, thrombosis of veins on the legs and poor healing of any wounds. Rarely, cardiac arrest, respiratory arrest, respiratory issues or a stroke can occur.